Epileptic Vertigo

Timothy C. Hain, MD

Last Edited: 10/2012

What is Epileptic Vertigo?

While epilepsy is commonly accompanied by dizziness or vertigo, vertigo is only rarely caused by epilepsy. This arises primarily because vertigo is much more commonly caused by ear conditions. Epileptic vertigo is due to brain injury, typically the part of the temporal lobe that processes vestibular signals. Loss of consciousness usually occurs at the time of injury. The typical symptom is “quick spins,” although this symptom has other potential causes (for example, BPPV or vestibular neuritis).

What Causes Epileptic Vertigo?

Epileptic vertigo is felt to be caused by abnormal stimulation of parts of the cortex that represent the vestibular system — parietal, temporal and frontal cortex. Based on brain imaging studies, researchers now feel that vestibular information is processed by several different coordinating areas within the brain (Altay, 2005; Kahane, 2003; Laff, 2003).Specific areas include the superior lip of the intraparietal sulcus, the posterior superior temporal lobe, and the temporal-parietal border regions (Penfield, 1954)

How is Epileptic Vertigo Diagnosed?

Epileptic vertigo is only a diagnostic problem when the person does not have a full seizure –in other words, they do not have convulsions, psychomotor symptoms or twitching characteristic of classic partial or generalized seizures.

In most instances, it presents as a “quick spin” type symptom. The person notes that the world makes a quick horizontal movement, lasting roughly one to two seconds at most. Quick spins must be differentiated from a variety of other conditions including vestibular neuralgia, Meniere’s Disease, and BPPV among others.

Diagnostic tests that are particularly helpful include the electroencephalograph (EEG), which detects abnormal electrical activity in the brain, and magnetic resonance imaging (MRI) scan of the head, which can detect a mass or lesion in the brain. In most patients, the combination of these two tests is all that is needed. However, individuals who do not experience relief of symptoms from medications may require additional testing, which may include video EEG monitoring, carotic amytal testing, ictal SPECT, neurophysiological evaluation, and intracranial EEG monitoring (Miskov, 2007). These tests can help to identify the location of the epileptic focus within the brain, and determine if it is surgically treatable.

How is Epileptic Vertigo Treated?

Treatment of epileptic vertigo is generally supervised by a Neurologist. Epileptic vertigo generally responds well to traditional anticonvulsants such as carbamazepine and its relatives. There are many anticonvulsant medications that can be used. Some patients may not experience relief with anticonvulsant therapy, and in these cases, surgery may be considered to remove the epileptic focus within the brain (Miskov, 2007).

Research Studies in Epileptic Vertigo

As of 9/2012, a visit to the National Library of Medicine’s search engine, Pubmed, revealed 359 research articles concerning epilepsy and vertigo published since 1868. At the American Hearing Research Foundation (AHRF), we have funded basic research on vertiginous conditions in the past, and are interested in funding sound research on vertigo in the future. Learn more about donating to American Hearing Research Foundation (AHRF) to diagnose and treat vertigo.

References

  • Altay E et al. Rotational vestibular epilepsy from temporo-parieto-occipital junction. Neurology 2005; 65(10):1675-1676.
  • Kahane P et al. Reappraisal of the human vestibular cortex by cortical electrical stimulation study. Annals of Neurology 2003;54(5):615-24.
  • Kluge M, and others. Epileptic vertigo: evidence for vestibular representation in human frontal cortex. Neurology 2000;55:1906-1908
  • Laff R et al. Epileptic kinetopsia: ictal illusory motion perception. Neurology 2003;61(9):1262-4.
  • Miscov S et al. The differential diagnosis of epilepsy and vertigo.
  • Penfield W, Jasper H. Epilepsy and functional anatomy of the humab brain. Boston: Little, Brown, 1954
  • Tusa RJ, Kaplan PW, Hain TC, Naidu S: Ipsiversive eye deviation and epileptic nystagmus. Neurology. 1990.